Tratamiento de infección por virus hepatitis C con nuevos antivirales en pediatría: a propósito de un caso / Treatment of hepatitis C virus infection with new direct-acting antivirals agents in pediatrics. Case report

La infección por virus de la hepatitis C en pediatría se produce principalmente por transmisión vertical. La historia natural en niños consiste en alta tasa de eliminación espontánea, infección asintomática o cambios histológicos mínimos. Las complicaciones suelen observarse en la adolescencia o en la edad adulta. El tratamiento clásico con interferón pegilado y ribavirina presenta efectos adversos, es de duración prolongada y logra una respuesta virológica sostenida (RVS) en el 50 % de los pacientes con infección por genotipo 1. Los nuevos antivirales de acción directa se encuentran disponibles para su indicación a partir de los 12 años, con excelente tolerancia y alta tasa de RVS. Se sugiere conducta terapéutica expectante en pacientes asintomáticos hasta acceder a la medicación. Reportamos el caso de un adolescente con hepatitis C crónica sin cirrosis que recibió tratamiento durante 12 semanas con ledipasvir/sofosbuvir y se logró una RVS.

Hepatitis C virus infection in children occurs mainly through vertical transmission. The natural history at this age consists in a high rate of spontaneous clearance, asymptomatic infection, or minimal histological changes. Disease complications are commonly seen in adolescence or adulthood. The classic treatment with pegylated interferon and ribavirin presents adverse effects, prolonged duration and achieves sustained viral response (SVR) in 50 % of patients with genotype 1 infection (the most frequent). New direct-acting antiviral treatments have been available in recent years for their indication from 12 years of age with excellent tolerance and a high SVR rate. Expectant therapeutic behavior is suggested in asymptomatic patients until they can access to them. We report the case of an adolescent with chronic hepatitis C without cirrhosis who received 12 weeks treatment with ledipasvir/sofosbuvir, achieving SVR.

Combination of Ledipasvir and Sofosbuvir for Treatment of Hepatitis C Virus Genotype 1 Infection: Systematic Review and Meta-Analysis

ABSTRACT Background and aim. The combination of Sofosbuvir (SOF) and Ledipasvir (LDV) has been lead to considerable enhancement of treatment of hepatitis C virus (HCV) genotype 1 infection. A meta-analysis of the currently available studies was undertaken with the aim to evaluate the antiviral efficacy of SOF/LDV therapy for 12 or 24 weeks with or without Ribavirin (RBV) in patients with HCV genotype 1 infection. Material and methods. In this meta-analysis, we searched databases including PubMed, Scopus, Science Direct and Web of Science using appropriate keywords. All papers which evaluated the efficacy of combination therapy of SOF/LDV with or without RBV for 12 or 24 weeks among patients with HCV genotype 1 infection were included. Results. The 20 published articles were assessed for eligibility and finally 10 articles pooling 2248 participants were included in this meta-analysis. Pooled SVR12 for four SOF/LDV regimens were 95% (95%CI = 93%-97%) for 12 weeks of treatment with SOF/LDV, 97% (95%CI = 95%-98%) for 24 weeks of treatment with SOF/LDV, 96% (95%CI = 94%-97%) for 12 weeks of treatment with SOF/ LDV/RBV and 98% (95%CI = 97%-99%) for 24 weeks of treatment with SOF/LDV/RBV. Only in treatment regimen of SOF/LDV for 12 weeks, cirrhosis had a significant effect on the SVR12 (OR = 0.21, 95%CI = 0.07-0.66). Furthermore, NS5A resistance-associated substitutions at baseline were associated with decrease in the rate of SVR (OR = 0.31, 95%CI = 0.2-0.5). Conclusions. The Interferon-free regimen of SOF/LDV for 12 or 24 weeks with or without RBV is highly effective for treatment of patients with HCV genotype 1 infection.

Candesartan, rather than losartan, improves motor dysfunction in thioacetamide-induced chronic liver failure in rats

Minimal hepatic encephalopathy is more common than the acute syndrome. Losartan, the first angiotensin-II receptor blocker (ARB), and candesartan, another widely-used ARB, have protected against developing fibrogenesis, but there is no clear data about their curative antifibrotic effects. The current study was designed to examine their effects in an already-established model of hepatic fibrosis and also their effects on the associated motor dysfunction. Low-grade chronic liver failure (CLF) was induced in 3-month old Sprague-Dawley male rats using thioacetamide (TAA, 50 mg·kg−1·day−1) intraperitoneally for 2 weeks. The TAA-CLF rats were randomly divided into five groups (n=8) treated orally for 14 days (mg·kg−1·day−1) as follows: TAA (distilled water), losartan (5 and 10 mg/kg), and candesartan (0.1 and 0.3 mg/kg). Rats were tested for rotarod and open-field tests. Serum and hepatic biochemical markers, and hepatic histopathological changes were evaluated by H&E and Masson's staining. The TAA-CLF rats showed significant increases of hepatic malondialdehyde, hepatic expression of tumor necrosis factor-α (TNF-α), and serum ammonia, alanine aminotransferase, γ-glutamyl transferase, TNF-α, and malondialdehyde levels as well as significant decreases of hepatic and serum glutathione levels. All treatments significantly reversed these changes. The histopathological changes were moderate in losartan-5 and candesartan-0.1 groups and mild in losartan-10 and candesartan-0.3 groups. Only candesartan significantly improved TAA-induced motor dysfunction. In conclusion, therapeutic antifibrotic effects of losartan and candesartan in thioacetamide-induced hepatic fibrosis in rats are possibly through angiotensin-II receptor blocking, antioxidant, and anti-inflammatory activities. Improved motor dysfunction by candesartan could be attributed to better brain penetration and slower "off-rate" from angiotensin-II receptors. Clinical trials are recommended.

Dislipidemias: ¿qué hay de nuevo? / Dyslipidemia: what's new?

En los últimos años han surgido algunas investigaciones y guías de práctica clínica relacionadas con el diagnóstico y tratamiento de las dislipidemias, que aportaron nuevos conocimientos (y controversias) sobre dicha problemática. En este resumen se describen, en primer lugar, las características de las "nuevas guías" norteamericanas para el manejo del colesterol publicadas a fines de 2013 y se comparan con las recomendaciones tradicionales. En segundo lugar, se analizan los últimos estudios que evaluaron el impacto cardiovascular de otros fármacos hipolipemiantes (ezetimibe y ácido nicotínico) en pacientes en prevención secundaria tratados con estatinas. Finalmente, se mencionan las nuevas drogas hipolipemiantes desarrolladas en los últimos años, como el lomitapide, el mipomersen y los inhibidores de la PCSK9, y se comentan el mecanismo de acción, su eficacia, sus efectos colaterales y los escenarios clínicos en donde podrían utilizarse. (AU)

In recent years, some research and clinical practice guidelines related to the diagnosis and treatment of dyslipidemia, which provided new knowledge (and controversy) about this problem have emerged. In this review, the characteristics of the American "new guidelines" for cholesterol management published by the end of 2013 are described, and they are compared with the traditional recommendations. In addition, recent studies assessing the cardiovascular impact of other lipid-lowering drugs (ezetimibe and nicotinic acid) in patients in secondary prevention treated with statins are analyzed. Finally, new hypolipidemic drugs developed in recent years are mentioned (lomitapide, mipomersen and PCSK9 inhibitors), discussing the mechanism of action, efficacy, side effects and clinical settings where they could be used. (AU)

Hope for Cirrhosis Patients with Genotype 1 Hepatitis C Virus Who Failed the Previous Treatment / 대한소화기학회지

No abstract available.

Nuevos fármacos para el tratamiento de la hipercolesterolemia / New lipid lowering agents

Statins are the preferred treatment for hypercholesterolemia and several studies have demonstrated their long-term safety and efficacy in reducing cardiovascular morbidity and mortality. However, in some cases of severe hypercholesterolemia such as homozygous and heterozygous familial hypercholesterolemia or statin intolerant patients, statins can be less efficient. In recent years, new lipid-lowering agents with novel mechanisms of action have been developed to reduce LDL-cholesterol in patients with severe hypercholesterolemia, associated or not to conventional lipid-lowering therapy. These therapies include microsomal transfer protein inhibitor (Lomitapide), antisense oligonucleotide to Apo B100 (Mipomersen) and monoclonal antibodies against Proprotein convertase subtilisin/kexin type 9 (PCSK9). Different studies have shown the great effectiveness of these new therapies. Short-term studies confirmed their adequate security profile, especially in patients with homozygous familiar hypercholesterolemia or severe hypercholesterolemia. Some of these agents have been also tested in statin-intolerant patients. However, long-term studies are needed to evaluate their safety, effectiveness and impact on cardiovascular risk reduction.

Hemodiálisis para remover el anticoagulante dabigatrán en situaciones de urgencia / Hemodialysis to remove anticoagulant dabigatran during emergencies

El dabigatrán es un nuevo inhibidor directo de la trombina, de administración oral, empleado para la prevención de eventos tromboembólicos en pacientes con fibrilación auricular no valvular. A diferencia de la warfarina, no se dispone de un antídoto conocido. La hemodiálisis ha sido sugerida como un método para remover el dabigatrán y reducir el efecto anticoagulante. Se presenta el caso de un paciente con antecedente de fibrilación auricular y medicado con dabigatrán, que fue admitido en el hospital para una cirugía abdominal de urgencia. A las seis horas de la última dosis recibida, los estudios de coagulación mostraban alteración. Ante la falta de antídoto para revertir los efectos, se decidió realizar hemodiálisis. Luego de tres horas de diálisis los parámetros de coagulación tendieron a normalizarse y el paciente fue operado sin presentar hemorragias anormales durante la cirugía o en el postoperatorio.

Dabigatran is an oral anticoagulant from the class of the direct thrombin inhibitors, indicated for prevention of thromboembolic events in patients with non valvular atrial fibrillation. Unlike warfarin, dabigatran has no known antidote. Hemodialysis has been suggested as a method for removing dabigatran and thereby reducing its anticoagulant effect. We report the case of a patient with a known history of atrial fibrillation, treated with dabigatran, who was admitted for emergency abdominal surgery. At six hours after the last dose received, coagulation studies were altered. In absence of an antidote to reverse its effects, it was decided to perform hemodialysis. After three hours of dialysis coagulation parameters were improved and the patient underwent surgery without showing abnormal bleeding during surgery or in the postoperative period.

Estudo do mecanismo de resistência a compostos derivados da classe das tiossemicarbazonas em tripanosomatídeos, com ênfase na glicoproteína-P e na nitrorredutase do tipo I / Study class of compounds derived from the resistance mechanism of thiosemicarbazones in trypanosomatids, with emphasis on P-glycoprotein and type I nitroreductase

Os tratamentos disponíveis para a doença de Chagas e as leishmanioses não são eficientes e apresentam alta toxicidade. Diversos estudos mostram que há possibilidade de indução de resistência de Trypanosoma cruzi ao Benznidazol (BZ) o que pode interferir na eficácia do tratamento. O mesmo tem sido relatado com relação aos fármacos utilizados para o tratamento das leishmanioses, embora não exista um mecanismo de ação definido para a resistência a drogas nestes protozoários. Neste trabalho foram focalizados dois potenciais mecanismos: 1) atividade da glicoproteína-P (Pgp), uma proteína de membrana que atua como uma bomba de efluxo dependente de energia e associada ao fenótipo de resistência a múltiplas drogas (MDR); 2) a enzima nitrorredutase presente em T. cruzi (TcNTR), reponsável pela redução de nitroderivados, como BZ, para obter o efeito tripanocida. Na busca de novos compostos seletivos contra T. cruzi e Leishmania amazonensis, nosso grupo vem estudando derivados da classe das tiossemicarbazonas. Em estudos prévios foi observado que o derivado 4-N-(2-metoxi-estiril)-tiossemicarbazona (2-MEOTIO) foi o composto mais efetivo sobre diferentes formas de T. cruzi, enquanto 4-N-(4’-hidroxi-3’-metoxi-estiril)-tiossemicarbazona (3-MEOTIO) se mostrou o mais eficiente contra L. amazonensisO mecanismo de resistência a estes compostos foi avaliado, e nossos resultados mostram a participação da Pgp na resistência a 2-MEOTIO e BZ em T. cruzi, e a 3-MEOTIO em L. amazonensis...

The available drugs for the treatment of Chagas disease and leishmaniasisare not efficient and cause toxic side effects. Several studies show the possibilityof drug resistance induction to Benznidazol (BZ) in Trypanosoma cruzi, whichmay interfere with the treatment efficacy. The same has been observed regardingcompounds used to treat leishmaniasis, although more studies on drug resistancemechanism are needed. In the present study we focused on two potential drugresistance mechanisms: 1) P-glycoprotein (Pgp) activity, a membrane proteinwhich acts as an efflux pump energy-dependent and is associated with themultidrug resistance fenotype (MDR); 2) the enzyme nitroreductase (TcNTR)found in T. cruzi, which is responsible for the reduction of nitroheterocyclicderivatives, such as Bz and Nifurtimox, generating metabolites with trypanocidalactivity. In the search for new selective drugs for the treatment of Chagas diseaseand leishmaniasis, our group has been studying compounds from the class of thethiosemicarbazones. Previous studies showed that the 4-N-(2-methoxy-styryl)-thiosemicarbazone (2-MEOTIO) was the most efficient compound on differentforms of T. cruzi, whereas 4-N-(4’-hidroxy-3’-methoxy styryl)-thiosemicarbazone(3-MEOTIO) was the most active on Leishmania amazonensis. Here weevaluated the drug resistance mechanism to both thiosemicarbazone derivatives,as well as, to BZ which was used as reference drug for T. cruzi. Our results showthe participation of Pgp in the resistance to both 2-MEOTIO and BZ in T. cruzi, aswell as in the resistance in L. amazonensis to the compound 3-MEOTIO.Interestingly, in T. cruzi the participation of Pgp is related to its localization notonly in the plasma membrane but also in the mithocondrion...

Effects of candesartan and propranolol combination therapy versus propranolol monotherapy in reducing portal hypertension

BACKGROUND/AIMS: Angiotensin receptor blockers (ARBs) inhibit activated hepatic stellate cell contraction and are thought to reduce the dynamic portion of intrahepatic resistance. This study compared the effects of combined treatment using the ARB candesartan and propranolol versus propranolol monotherapy on portal pressure in patients with cirrhosis in a prospective, randomized controlled trial. METHODS: Between January 2008 and July 2009, 53 cirrhotic patients with clinically significant portal hypertension were randomized to receive either candesartan and propranolol combination therapy (26 patients) or propranolol monotherapy (27 patients). Before and 3 months after the administration of the planned medication, the hepatic venous pressure gradient (HVPG) was assessed in both groups. The dose of propranolol was subsequently increased from 20 mg bid until the target heart rate was reached, and the candesartan dose was fixed at 8 mg qd. The primary endpoint was the HVPG response rate; patients with an HVPG reduction of >20% of the baseline value or to <12 mmHg were defined as responders. RESULTS: The mean portal pressure declined significantly in both groups, from 16 mmHg (range, 12-28 mmHg) to 13.5 mmHg (range, 6-20 mmHg) in the combination group (P<0.05), and from 17 mmHg (range, 12-27 mmHg) to 14 mmHg (range, 7-25 mmHg) in the propranolol monotherapy group (P<0.05). However, the medication-induced pressure reduction did not differ significantly between the two groups [3.5 mmHg (range, -3-11 mmHg) vs. 3 mmHg (range, -8-10 mmHg), P=0.674]. The response rate (55.6% vs. 61.5%, P=0.435) and the reductions in mean blood pressure or heart rate also did not differ significantly between the combination and monotherapy groups. CONCLUSIONS: The addition of candesartan (an ARB) to propranolol confers no benefit relative to classical propranolol monotherapy for the treatment of portal hypertension, and is thus not recommended.

A Case of Fascioliasis in the Intrahepatic Duct with Concurrent Clonochiasis / 대한소화기학회지

The main causes of biliary obstruction are stones and cancers. Fascioliasis is a very rare case which causes biliary obstruction. Fascioliasis is a zoonosis caused by Fasciola hepatica which infects herbivores like sheep and cattle. F. hepatica lives in the biliary system or the liver parenchyma of a host. In Korea, the occurrence of this infection in human is very rare and only few cases have been reported. A 32-year-old male presented with upper abdominal pain and jaundice. His laboratory finding revealed elevated liver transaminases. Abdomen CT scan showed mild left intrahepatic bile duct dilatation. On ERCP, adult F. hepatica worms were found and were thus removed. Concurrently, clonorchiasis was diagnosed by stool exam and serologic enzyme-linked immunosorbent assay test. Clonorchiasis was treated with praziquantel. Herein, we report a case of intrahepatic bile duct dilatation due to F. hepatica infection with concurrent Clonorchis sinensis infestation.

Frequency of benzimidazole resistance in Haemonchus contortus populations isolated from buffalo, goat and sheep herds / Frequência da resistência ao benzimidazol em populações de Haemonchus contortus isoladas de rebanhos de bubalinos, caprinos e ovinos

Anthelmintic resistance is an increasing problem that threatens livestock production worldwide. Understanding of the genetic basis of benzimidazole resistance recently allowed the development of promising molecular diagnostic tools. In this study, isolates of Haemonchus contortus obtained from goats, sheep and buffaloes raised in Brazil were screened for presence of the polymorphism Phe200Tyr in the β-tubulin 1 gene, which confers resistance to benzimidazole. The allelic frequency of the mutation conferring resistance ranged from 7% to 43%, and indicated that resistance to benzimidazole could be found in nematodes isolated from all the ruminant species surveyed. Although significant variation in the frequency of the F200Y mutation was observed between different herds or host species, no significant variation could be found in populations isolated from animals within the same herd. These findings suggest that screening of samples from a few animals has the potential to provide information about the benzimidazole resistance status of the entire herd, which would enable a considerable reduction in the costs of diagnosis for the producer. Molecular diagnosis has practical advantages, since it can guide the choice of anthelmintic drug that will be used, before its application in the herd, thus reducing the economic losses driven by anthelmintic resistance.

A resistência aos anti-helmínticos é um problema crescente que ameaça a produção pecuária em todo o mundo. A compreensão da base genética da resistência ao benzimidazol permitiu, recentemente, o desenvolvimento de métodos diagnósticos moleculares promissores. Neste estudo, isolados de Haemonchus contortus obtidos a partir de rebanhos de caprinos, ovinos e bubalinos criados no Brasil foram avaliados quanto à presença do polimorfismo F200Y no gene da β-tubulina1, o qual confere resistência ao benzimidazol. A frequência alélica da mutação variou de 7% a 43%, indicando que a resistência ao benzimidazol pode ser encontrada em nematoides isolados a partir de todas as espécies de ruminantes pesquisadas. Embora tenha sido observada variação significativa das frequências de mutação F200Y entre rebanhos/espécies hospedeiros distintos, não foi encontrada variação significativa entre populações isoladas de animais dentro de um mesmo rebanho. Estes achados sugerem que a avaliação de amostras de alguns poucos animais tem o potencial de fornecer informações sobre o nível de resistência ao benzimidazol de todo o rebanho, possibilitando uma redução considerável dos custos de diagnóstico para o produtor. O diagnóstico molecular apresenta vantagens práticas, uma vez que pode guiar a escolha da base anti-helmíntica a ser utilizada antes da sua aplicação no rebanho, reduzindo, portanto, as perdas ocasionadas pela resistência aos fármacos anti-helmínticos.

Ramosetron might be useful for treating diabetic diarrhea with a rapid small bowel transit time

No abstract available.

Obstrucción biliar por fascioliasis hepática / Biliary obstruction due to hepatic fascioliasis

Hepatic fascioliasis is produced by a platyhelminth, trematode: the hepatic Fasciola. In recent years, its incidence has increased in all countries, including Latin America. The diagnosis is based on clinical and epidemiological background information, hemogramm with eosinophil count; Ig G ELISA; and copro-parasitological and duodenal aspirate in search of parasite eggs. Images are useful, endoscopic ultrasound, Computed Tomography (CT), abdominal Magnetic Resonance Imaging (MRI), especially in case of complications. The endoscopic retrograde cholangiopancreatography (ERCP) is useful both for diagnosis and treatment (extraction of adult Fasciola), as it was in hte present clinical case. This parasite can also be found incidentally in the course of a surgery planned for other reasons. In the present clinical case we present a 41-year-old patient, farmer, with apparent ingestion of water and contaminated aquatic vegetables. Initially he presented only fever and hypereosinophilia; with fascioliasis diagnosis. The pathology recurred after 18 month with biliary obstruction. The clinical and epidemiological background information was a fundamental tool for diagnosis, together with abdominal CT. Initially it evolved with bad response to several antiparasitic treatments and then it progressed positively. After that, the pathology recurred with complications. ERCP was performed to extract adult Fasciola. Currently in symptomatic remission after endoscopic intervention and drug treatment.

La fascioliasis hepática es producida por un platelminto, tremátodo: la Fasciola hepática. En los últimos años ha incrementado su incidencia en todos los países, incluyendo América Latina. El diagnóstico se basa en los antecedentes clínicos, epidemiológicos, hemograma con recuento de eosinófilos; IgG Elisa; copro-parasitológicos y aspirado duodenal en búsqueda de huevo de parásitos. Las imágenes son de utilidad, endosonografía, tomografía computada (TC), resonancia magnética (RM) abdominal, especialmente en caso de complicaciones. La colangio-pancreatografía retrógrada endoscópica (CPRE) es útil tanto como para el diagnóstico como para el tratamiento (extracción de fasciolas adultas), como se realizó en el presente caso clínico. Este parásito también se puede encontrar incidentalmente en el transcurso de una cirugía por otros motivos. Presentamos el caso de un paciente de 41 años, originario de una zona rural, agricultor, con ingesta aparente de agua y vegetales acuáticos contaminados. Cursó inicialmente sólo con fiebre e hipereosinofilia; con diagnóstico de fascioliasis. Al cabo de 18 meses su patología recurrió con cuadro clínico de obstrucción biliar. El antecedente clínico y epidemiológico fue una herramienta fundamental para el diagnóstico, además, de la TC abdominal. Evolucionó inicialmente con mala respuesta a varios tratamientos antiparasitarios, y luego mejoró. Posteriormente, su patología recurrió con complicaciones. Se realizó CPRE con extracción de Fasciolas adultas. Actualmente, se encuentra en remisión sintomática mantenida, después de la intervención endoscópica y el tratamiento medicamentoso.

In vitro effects of triclabendazole [TCBZ] on the excretory-secretory products [ESP] of fasciola spp parasites

Fascioliasis is an endemic disease in Iran and triclabendazole [TCBZ] is using for treatment of domestic animals and infected people. Excretory-secretory products [ESP] play an important role in the host biochemical defense by means of activities of detoxifying and antioxidant glutathione S-transferase [GST] and superoxide dismutase [SOD] enzymes respectively. Therefore, the aim of this comparative study was to evaluate fasciola protection against TCBZ drug by detection of enzymatic activities, GST and SOD, in TCBZ treated Fasciola hepatica / Fasciola gigantica and control ESP samples. F. gigantic and F. hepatica helminthes were collected and cultured within buffer media [TCBZ treated and untreated or control] for 4 h at 37[degree]C. Three TCBZ treated and 1 control ESP samples for each species were collected, centrifuged and supernatants were stored at-20°C. ESP samples protein concentrations were measured by Bradford method. SOD and GST enzymes activities of ESP samples were estimated photometrically. To determine the statistically significant difference between ESP of treated and control samples, t-test was conducted. ESP protein bands were detected by sodium dodecyl sulfate polyacrylamide gel electrophoresis [SDS-PAGE]. Protein concentrations in treated F. hepatica and F. gigantica ESP samples were estimated 204.88, 428, 130.4 and 288.2, 488.2, 308.2 micro g/ml respectively. Protein concentrations in control samples were estimated 488.18 and 124.8 micro g/ml respectively. SOD enzyme specific activities level in treated F.hepatica and F. gigantica ESP samples were determined 0.14, 0.31, 3.96 and 11.11, 13.54, 19.95 U/mg/protein respectively. SOD activities level in control samples were detected 70.69 and 10.92 U/mg/protein. GST specific activities level in treated F.hepatica and F. gigantica ESP samples were calculated 25.3, 85.5, 37.3 and 1823, 1314.3, 1320.8 U/mg respectively. GST activities levels in control samples were detected 98.6 and 1083.9 U/mg/protein respectively. Statistical analysis reveal the significant different between proteins concentrations, GST and SOD enzyme specific activities of TCBZ treated ESP samples of F. gigantic in comparison to the control samples [P<0.05], however, is not significant for treated F. hepatica and control ESP samples [P>0.05]. There is no difference between SDS-PAGE results of treated and control samples. Based on the results of the present work, significant increase of enzymatic activities of GST and SOD in TCBZ treated F. gigantica ESP, it seems, the protection of this species against drug is higher than F. hepatica

Comportamiento clínico-terapéutico de Fasciola hepatica en una serie de 87 pacientes / Clinical and therapeutic behaviour of Fasciola hepatica in a series of 87 patients

Introducción: la fasciolosis, por Fasciola hepatica, muestra a escala mundial un incremento en la incidencia de enfermos en los últimos años. Cuba se encuentra entre aquellos países donde se reportan casos esporádicos y algunos brotes epidémicos. Objetivo: describir el comportamiento clínico-terapéutico de esta trematodiosis de trasmisión digestiva en una serie de 87 pacientes ingresados en el Instituto de Medicina Tropical "Pedro Kourí" desde enero de 1996 a diciembre de 2005. Método: los pacientes se dividieron en 2 grupos atendiendo al fármaco prescrito, dihidroemetina o triclabendazol. Se recogieron las variables clínicas al inicio del diagnóstico y 90 d después del tratamiento; se hallaron las medias y la desviación estándar. Resultados: el sexo masculino predominó discretamente con 54 por ciento en nuestra serie de pacientes ingresados en el servicio de medicina tropical del instituto. La ingestión de berro (Nasturtium officinale) estuvo presente en casi la mitad de los pacientes. El dolor abdominal, fiebre y astenia resultaron los síntomas de mayor frecuencia. El triclabendazol y la dihidroemetina fueron útiles en el tratamiento. Conclusiones: se comprobó la utilidad de los exámenes de laboratorio en el diagnóstico y seguimiento de los enfermos. Los antiparasitarios dihidroemetina y triclabendazol resultaron efectivos a las dosis utilizadas con efectos adversos menores.

Introduction: in the last few years, the Incidence rate of fascioliosis caused by Fasciola hepatica has increased worldwide. Cuba is one of the countries that have reported sporadic cases and also some outbreaks of fasciolosis. Objective: to describe clinical and therapeutic features of this trematodiasis of digestive transmission found in 87 patients, who had been admitted to "Pedro Kourí" Institute of Tropical Medicine from January 1996 to December 2005. Methods: patients were divided into 2 groups according to the prescribed drug, that is, triclabendazole and dihydroemetine. The clinical variables were collected at the time of diagnosis and 90 days after treatment; the means and the standard deviation were estimated. Results: males was slightly predominant (54) in our series of patients admitted to the institute service. Consumption of watercress (Nasturtium officinale) was found in almost half of the patients. Abdominal pain, fever and malaise were the most frequent symptoms. Both drugs were useful to treat F. hepatica. Conclusions: this study showed the usefulness of lab tests for diagnosis and follow-up of patients after treatment. The anti-parasitic drugs dihydroemetine and triclabendazole proved to be effective at the prescribed doses in this research with minor adverse effects.

A pilot study on the effect of telmisartan & ramipril on 24 h blood pressure profile & dipping pattern in type 1 diabetes patients with nephropathy.

Background & objectives: Angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have been used to normalize the blood pressure and the dipping pattern in patients with type 1 diabetes mellitus (T1DM) and nephropathy. However, there are no data on the effect of the dual blockade on the dipping pattern in these subjects. We therefore, carried out this study to evaluate the effect of administrating an ACEI followed by ARB in the optimum doses in T1DM patients with nephropathy on 24 h blood pressure (BP) profile and nocturnal dipping pattern. Methods: An open label interventional pilot study was done during a one year period involving 30 consecutive patients who were treated with telmisartan 80 mg (0800-1000 h) for eight weeks followed by addition of ramipril 10 mg (1200-1400 h) for the next eight weeks. Ambulatory BP, dipping pattern and albumin excretion rate were studied after each phase. Twenty patients were hypertensive and 10 patients had macro- and 20 patients had microalbuminuria. Results: Telmisartan produced a fall in the clinic BP by 4/1.3 mm Hg (P<0.05 and P<0.362, respectively), 2/1.9 mm Hg in the mean 24 h BP, 1.4/1.1 mm Hg in the day BP and 3.7/3 mm Hg in the trough BP. Addition of ramipril to telmisartan produced a further reduction of 6.3/5.9 mm Hg in the clinic BP (P<0.001 for both), 4.3/4.2 mm Hg in the mean 24 h BP (P<0.01 and P<0.0001, respectively), 5.8/3.9 mm Hg in the day BP (P<0.01 for both), 4.2/2.5 mm Hg in the trough BP, with a reduction of clinic SBP and DBP of 10.3/7.2 mm Hg from the baseline. Telmisartan restored normal systolic dipping pattern in 33.3 per cent of the nondippers (P<0.01) but addition of ramipril was not complimentary. Hyperkalamia (>5.5 mmol/l) was observed only in 2 patients towards the end of the study. Interpretation & conclusions: The dual blockade with telmisartan and ramipril had complimentary effect on lowering of the BP, however, similar beneficial effect on the nocturnal dipping was not observed. Further studies with large number of subjects with longer duration of follow-up are required to validate these observations.

A Paragonimiasis Patient with Allergic Reaction to Praziquantel and Resistance to Triclabendazole: Successful Treatment after Desensitization to Praziquantel

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.